<div class="bjui-pageContent">
<form action="/admin/system/company-edit" id="plate-add-form" data-toggle="ajaxform" data-options="{closeCurrent:true,okAfterCallback:refreshList}">
    <div class="bjui-row">
        <div class="bjui-row col-2">
            <label class="row-label">工厂名称</label>
            <div class="row-input required">
                <input type="text" name="title" id="title" data-rule="required">
            </div>
        </div>
        <div class="bjui-row col-2">
            <label class="row-label">领取材料</label>
            <div class="row-input">
                <select name="supplier_level" id="supplier_level" data-toggle="selectpicker">
                    <option value="0">不需要扫描</option>
                    <option value="1">需要扫描</option>
                </select>
            </div>
        </div>
        <div class="bjui-row col-2">
            <label class="row-label">LOGO图片（商标）</label>
            <div class="row-input">
                <input type="file" data-name="logo" data-toggle="webuploader" data-options="
                    {
                        pick: {label: '点击选择图片'},
                        server: 'admin/photo/upload',
                        upname:'logo',
                        fileNumLimit: 1,
                        formData: {_token : '{{ csrf_token() }}',path_type:3},
                        required: false,
                        uploaded: '',
                        basePath: '',
                        accept: {
                            title: '图片',
                            extensions: 'jpg,png',
                            mimeTypes: '.jpg,.png'
                        }
                    }">
            </div>
        </div>
        <div class="bjui-row col-2">
            <label class="row-label">营业执照（五合一）</label>
            <div class="row-input">
                <input type="file" data-name="business_licence" data-toggle="webuploader" data-options="
                    {
                        pick: {label: '点击选择图片'},
                        server: 'admin/photo/upload',
                        upname:'business_licence',
                        fileNumLimit: 1,
                        formData: {_token : '{{ csrf_token() }}',path_type:3},
                        required: false,
                        uploaded: '',
                        basePath: '',
                        accept: {
                            title: '图片',
                            extensions: 'jpg,png',
                            mimeTypes: '.jpg,.png'
                        }
                    }">
            </div>
        </div>
        <div class="bjui-row col-2">
            <label class="row-label">行业许可证</label>
            <div class="row-input">
                <input type="file" data-name="industry_license" data-toggle="webuploader" data-options="
                    {
                        pick: {label: '点击选择图片'},
                        server: 'admin/photo/upload',
                        upname:'industry_license',
                        fileNumLimit: 1,
                        formData: {_token : '{{ csrf_token() }}',path_type:3},
                        required: false,
                        uploaded: '',
                        basePath: '',
                        accept: {
                            title: '图片',
                            extensions: 'jpg,png',
                            mimeTypes: '.jpg,.png'
                        }
                    }">
            </div>
        </div>
        <div class="bjui-row col-2">
            <label class="row-label">其他资质证书</label>
            <div class="row-input">
                <input type="file" data-name="other_license" data-toggle="webuploader" data-options="
                    {
                        pick: {label: '点击选择图片'},
                        server: 'admin/photo/upload',
                        upname:'other_license',
                        fileNumLimit: 1,
                        formData: {_token : '{{ csrf_token() }}',path_type:3},
                        required: false,
                        uploaded: '',
                        basePath: '',
                        accept: {
                            title: '图片',
                            extensions: 'jpg,png',
                            mimeTypes: '.jpg,.png'
                        }
                    }">
            </div>
        </div>
        <div class="bjui-row col-2">
            <label class="row-label">联系人</label>
            <div class="row-input">
                <input type="text" name="contacts_name" id="contacts_name" size="">
            </div>
        </div>
        <div class="bjui-row col-2">
            <label class="row-label">联系人手机号</label>
            <div class="row-input">
                <input type="text" name="mobile" id="mobile" size="">
            </div>
        </div>
        <div class="bjui-row col-2">
            <label class="row-label">收货人</label>
            <div class="row-input">
                <input type="text" name="consignee_name" id="consignee_name" size="">
            </div>
        </div>
        <div class="bjui-row col-2">
            <label class="row-label">收货人电话</label>
            <div class="row-input">
                <input type="text" name="consignee_tel" id="consignee_tel" size="">
            </div>
        </div>

        <div class="bjui-row col-2">
            <label class="row-label">收货地址</label>
            <div class="row-input">
                <select name="province_id" id="province_id" data-nextselect="#city_id" data-toggle="selectpicker" data-refurl="admin/address/ajaxAreaList?type=2&value={value}">
                    <option value="">请选择</option>
                    @foreach ($provinceList as $val)
                        <option value="{{$val['provinceID']}}">{{$val['province']}}</option>
                    @endforeach
                </select>
                <select name="city_id" id="city_id" data-nextselect="#area_id" data-toggle="selectpicker" data-refurl="admin/address/ajaxAreaList?type=3&value={value}">
                    <option value="">请选择</option>
                </select><br>
                <select name="area_id" id="area_id" >
                    <option value="">请选择</option>
                </select>
            </div>
        </div>
        <div class="bjui-row col-2">
            <label class="row-label">收货详细地址</label>
            <div class="row-input">
                <input type="text" name="address" id="address">
            </div>
        </div>


        <div class="bjui-row col-1">
            <label class="row-label" style="margin-left:100px;">以下为开票信息</label>
        </div>
        <hr style="margin-top:-10px;">

        <div class="bjui-row col-2">
            <label class="row-label">名称</label>
            <div class="row-input">
                <input type="text" name="invoice_account_name" id="invoice_account_name" ">
            </div>
        </div>

        <div class="bjui-row col-2">
            <label class="row-label">电话</label>
            <div class="row-input">
                <input type="text" name="invoice_telphone" id="invoice_telphone" ">
            </div>
        </div>

        <div class="bjui-row col-2">
            <label class="row-label">纳税人识别号</label>
            <div class="row-input">
                <input type="text" name="invoice_taxpayer_number" id="invoice_taxpayer_number" ">
            </div>
        </div>

        <div class="bjui-row col-2">
            <label class="row-label">开户行</label>
            <div class="row-input">
                <input type="text" name="invoice_opening_bank" id="invoice_opening_bank" ">
            </div>
        </div>

        <div class="bjui-row col-2">
            <label class="row-label">账号</label>
            <div class="row-input">
                <input type="text" name="invoice_bank_card_number" id="invoice_bank_card_number">
            </div>
        </div>

        <div class="bjui-row col-2">
            <label class="row-label">所在地区</label>
            <div class="row-input">
                <select name="invoice_province_id" id="invoice_province_id" data-nextselect="#invoice_city_id" data-toggle="selectpicker"  data-refurl="admin/address/ajaxAreaList?type=2&value={value}">
                    <option value="">请选择</option>
                    @foreach ($provinceList as $val)
                        <option value="{{$val['provinceID']}}" >{{$val['province']}}</option>
                    @endforeach
                </select>
                <select name="invoice_city_id" id="invoice_city_id" data-nextselect="#invoice_area_id" data-toggle="selectpicker"  data-refurl="admin/address/ajaxAreaList?type=3&value={value}">
                    <option value="">请选择</option>
                </select><br>
                <select name="invoice_area_id" id="invoice_area_id" >
                    <option value="">请选择</option>
                </select>
            </div>
        </div>
        <div class="bjui-row col-2">
            <label class="row-label">详细地址</label>
            <div class="row-input">
                <input type="text" name="invoice_address" id="invoice_address" >
            </div>
        </div>



    </div>
</form>
</div>

<div class="bjui-pageFooter">
    <ul>
        <li>
            <button type="submit" class="btn-default" data-icon="save">保存</button>
        </li>
        <li>
            <button type="button" class="btn-close" data-icon="close">取消</button>
        </li>
    </ul>
</div>